Approval Of Requests Research Articles

Anti-VEGF Pharmaceutical Prior Authorization in Retina Practices

Anti-vascular endothelial growth factor (VEGF) intravitreal injections, a mainstay of treatment for many retinal diseases to optimize visual outcomes, have been included in prior authorization (PA) initiatives. However, if clinicians are extremely accurate in their use of anti-VEGF medications, such administrative burdens may need reconsideration. To quantify PA for anti-VEGF medications (aflibercept, ranibizumab, and bevacizumab) that were approved and determine associated administrative burdens experienced by retina practices. Prospective multicenter quality improvement study conducted from January 2022 through June 2022, and participants were 9 private retina practices across the US. Overall rate of approval of PA requests, reasons for requesting PA, and overall rate of delay of care resulting from PA procedures. In total, 2365 PA requests were recorded, 2225 of which met inclusion criteria. Overall, 2140 (96.2%) requests were approved. The most common reason for requesting PA, at 64% (1423 of 2225 requests), was reauthorization for a previously utilized medication. Of the 2140 approvals, 59.6% (1277) resulted in a delay in care greater than 24 hours, and 40% (863) were given on the date of service. In a granular analysis of a subset of delayed approvals, 23.9% (173 of 725) were approved within 1 day, 15.9% (115 of 725) were approved within 2 to 3 days, 21.5% (156 of 725) were approved within 4 to 7 days, 26.3% (191 of 725) were approved within 8 to 31 days, and 12.4% (90 of 725) were approved within more than 31 days. Overall, PA denial for step therapy was 2.9% (65 of 2225) of requests and uncovered diagnoses was 0.9% (20 of 2225) of requests. The median staff time spent to obtain a single PA was 100 (range, 0-200) minutes. In this study, PA requests were almost always approved but led to a delay in patient care in most patients. The current study suggests that the PA process may not be effective for retina specialists if these results can be generalized to other practices in the US and if less burdensome and less costly approaches could result in similar approval rates. Potential short-term solutions may include eliminating the PA process for bevacizumab and reauthorizations for established patients.

Advancing Preauthorization Task in Healthcare: An Application of Deep Active Incremental Learning for Medical Text Classification

This study presents a novel approach to medical text classification using a deep active incremental learning model, aiming to improve the automation of the preauthorization process in medical health insurance. By automating decision-making for request approval or denial through text classification techniques, the primary focus is on real-time prediction, utilization of limited labeled data, and continuous model improvement. The proposed approach combines a Bidirectional Long Short-Term Memory (Bi-LSTM) neural network with active learning, using uncertainty sampling to facilitate expert-based sample selection and online learning for continuous updates. The proposed model demonstrates improved predictive accuracy over a baseline Long Short-Term Memory (LSTM) model. Through active learning iterations, the proposed model achieved a 4% improvement in balanced accuracy over 100 iterations, underscoring its efficiency in continuous refinement using limited labeled data.

Hazard testing to reduce risk in the development of automated planning tools.

Hazard scenarios were created to assess and reduce the risk of planning errors in automated planning processes. This was accomplished through iterative testing and improvement of examined user interfaces. Automated planning requires three user inputs: a computed tomography (CT), a prescription document, known as the service request, and contours. We investigated the ability of users to catch errors that were intentionally introduced into each of these three stages, according to an FMEA analysis. Five radiation therapists each reviewed 15 patient CTs, containing three errors: inappropriate field of view, incorrect superior border, and incorrect identification of isocenter. Four radiation oncology residents reviewed 10 service requests, containing two errors: incorrect prescription and treatment site. Four physicists reviewed 10 contour sets, containing two errors: missing contour slices and inaccurate target contour. Reviewers underwent video training prior to reviewing and providing feedback for various mock plans. Initially, 75% of hazard scenarios were detected in the service request approval. The visual display of prescription information was then updated to improve the detectability of errors based on user feedback. The change was then validated with five new radiation oncology residents who detected 100% of errors present. 83% of the hazard scenarios were detected in the CT approval portion of the workflow. For the contour approval portion of the workflow none of the errors were detected by physicists, indicating this step will not be used for quality assurance of contours. To mitigate the risk from errors that could occur at this step, radiation oncologists must perform a thorough review of contour quality prior to final plan approval. Hazard testing was used to pinpoint the weaknesses of an automated planning tool and as a result, subsequent improvements were made. This study identified that not all workflow steps should be used for quality assurance and demonstrated the importance of performing hazard testing to identify points of risk in automated planning tools.

PRETRIAL JUDGE’S AUTHORITY IN ADJUDICATING ADMINISTRATIVE ACTIONS BY THE DIRECTORATE GENERAL OF CUSTOMS

The Directorate General of Customs and Excise has both administrative and law enforcement authority, which judges commonly interpret as including investigative powers, leading to the approval of pretrial requests for administrative actions. This research utilizes normative legal research with a descriptive qualitative approach, using qualitative analysis techniques and a range of legal materials. It finds that interpretations of administrative authority among pretrial judges vary, with only two out of five considering it beyond pretrial scrutiny. This suggests a potential overreach in judicial interpretation regarding the administrative actions of Customs and Excise. The research recommends issuing a Supreme Court Circular or amending the Customs and Excise Law to clearly define and limit such authority, thereby preventing expansive judicial interpretation of enforcement powers..

Optimising older adults’ home spaces to enhance their physical activity level: an exploratory qualitative study protocol

IntroductionHousing is a major contributing factor to health, and better housing condition has been linked to improved general and psychological health. There has also been strong evidence that the physical...

Setting up a Governance Framework for Secondary Use of Routine Health Data in Nursing Homes: Development Study Using Qualitative Interviews

In the nursing home sector, reusing routinely recorded data from electronic health records (EHRs) for knowledge development and quality improvement is still in its infancy. Trust in appropriate and responsible reuse is crucial for patients and nursing homes deciding whether to share EHR data for these purposes. A data governance framework determines who may access the data, under what conditions, and for what purposes. This can help obtain that trust. Although increasing attention is being paid to data governance in the health care sector, little guidance is available on development and implementation of a data governance framework in practice. This study aims to describe the development process of a governance framework for the "Registry Learning from Data in Nursing Homes," a national registry for EHR data on care delivered by nursing home physicians (in Dutch: specialist ouderengeneeskunde) in Dutch nursing homes-to allow data reusage for research and quality improvement of care. Relevant stakeholders representing practices, policies, and research in the nursing home sector were identified. Semistructured interviews were conducted with 20 people from 14 stakeholder organizations. The main aim of the interviews was to explore stakeholders' perspectives regarding the Registry's aim, data access criteria, and governing bodies' tasks and composition. Interview topics and analyses were guided by 8 principles regarding governance for reusing health data, as described in the literature. Interview results, together with legal advice and consensus discussions by the Registry's consortium partners, were used to shape the rules, regulations, and governing bodies of the governance framework. Stakeholders valued the involvement of nursing home residents and their representatives, nursing home physicians, nursing homes' boards of directors, and scientists and saw this as a prerequisite for a trustworthy data governance framework. For the Registry, involvement of these groups can be achieved through a procedure in which residents can provide their consent or objection to the reuse of the data, transparency about the decisions made, and providing them a position in a governing body. In addition, a data request approval procedure based on predefined assessment criteria indicates that data reuse by third parties aligns with the aims of the Registry, benefits the nursing home sector, and protects the privacy of data subjects. The stakeholders' views, expertise, and knowledge of other frameworks and relevant legislation serve to inform the application of governance principles to the contexts of both the nursing home sector and the Netherlands. Many different stakeholders were involved in the development of the Registry Learning from Data in Nursing Homes' governance framework and will continue to be involved. Engagement of the full range of stakeholders in an early stage of governance framework development is important to generate trust in appropriate and responsible data reuse.

Development of Regulations and Problems in the Conversion of Agricultural/Paddy Land Functions and Their Resolving With Land Incompatibility in Indonesia

The spatial plans that have been made so far have not prioritized paddy or agricultural land; this is reflected in the fact that the regional governments have not issued any spatial plans related to paddy or agricultural land. Recently, real threats have occurred because the transfer of agricultural land or rice fields has been the subject of discussion at the level of environmental experts or by the central government through the relevant ministries. Whereas the conversion of agricultural land and rice fields in the last two to three years has become a priority of the Central Government with the issuance of legal products from presidential regulations to the relevant ministries, The determination of a map of paddy fields protected by the Ministry of Agrarian Affairs and Spatial Planning Head on December 16, 2021, is a positive thing for policy makers at the local government level and should be used as a basis for giving approval or rejection of requests for land conversion changes in the future. Regarding the discrepancy (overlapping) of protected paddy fields against the existing spatial plan (RTR).

HAKIKAT PERSETUJUAN MAJELIS KEHORMATAN NOTARIS SEBAGAI UPAYA PERLINDUNGAN HUKUM PADA NOTARIS DALAM PROSES PERADILAN

This study aims to: (1) analyze and discover the nature of the approval of the Notary Honorary Council as an effort to protect the law against notaries in the judicial process; (2) Analyze and find law enforcement for Notaries related to Professional Ethics. This type of research is normative law. While the research approach used, namely: Legislation, conceptual approach, and case approach, as well as a comparative approach. The legal materials used in this study are primary legal materials and secondary legal materials. While the analysis of legal materials using qualitative analysis.
 The results of the study show that: (1) The regional MKN has the authority to examine applications submitted by investigators, public prosecutors or judges; as well as giving approval or rejection of requests for approval to take photocopies of minuta deed and summons Notaries to attend investigations, prosecutions, and judicial processes (66 paragraph (1) UUJNP), (2) Sanctions imposed on Notaries who violate the professional code of ethics are regulated in Article 85 UUJN, namely in the form of: Verbal warning; Written warning; temporary stop; Honorable discharge; and Dishonorable Dismissal by the Notary Honorary Council.

PB1805: INSIGHTS FROM ORAL AZACITIDINE EARLY ACCESS PROGRAM IN FRANCE: PATIENT POPULATION WITH ACUTE MYELOID LEUKEMIA RECEIVING ORAL-AZA FOR MAINTENANCE OF COMPLETE REMISSION AFTER INDUCTION CHEMOTHERAPY

Background: While many older patients with acute myeloid leukemia (AML) reach complete remission (CR) with intensive chemotherapy (IC), ~80% will ultimately relapse. Treatment options in relapse settings are limited and outcome is usually poor. The randomized, placebo-controlled, phase 3 QUAZAR AML-001 trial evaluated oral azacitidine (Oral-AZA; formerly CC-486), a hypomethylating agent, in patients with AML in first remission (CR1) after IC, who were not eligible for hematopoietic stem cell transplantation (HSCT). Unprecedentedly in AML, maintenance treatment with Oral-AZA was associated with significantly longer overall survival and relapse-free survival compared with placebo. Therefore, Oral-AZA received a marketing authorization in the EU as maintenance therapy in adult patients with AML who achieved CR or CR with incomplete blood count recovery (CRi) following induction therapy with or without consolidation treatment and who are not candidates for, including those who choose not to proceed to, HSCT. Also, French health Authority enabled an early access to Oral-AZA in this indication via a Temporary Authorization for Use (ATU) that started in June 2021. Aims: The aim of the study was to describe the characteristics of patients with newly diagnosed AML who received Oral-AZA for maintenance of CR/CRi after IC and consolidation treatment, who were not eligible for HSCT and were enrolled into ATU in France. Methods: ATU is a French early access allowing administration of the drug under a Therapeutic Use Protocol approved by health authorities. Data presented in this abstract were collected on a declaratory basis and were not monitored. A total of 52 patients were included in 32 centers across France and treated with Oral-AZA during the period from 09-Jun-2021 to 14-Sep-2021. Oral-AZA monotherapy was administered at 300mg once daily for 14 days per 28-days cycle. Results: Overall, 52 treated patients were included with a median age of 67.5 years [range: 35-85]. Regarding Performance Status, 22/52 (42.3%) had an ECOG 0, 25/52 (48.1%) 1 and 5/52 (9.6%) ≥2. The majority (43/52 [82.7%]) had a diagnosis of de novo AML, and the genetic risk (according to ELN2017 criteria) was favorable for 13/52 (25.0%), intermediate for 22/52 (42.3%) and adverse for 17/52 (32.7%) of the patients. Most of the patients had received 1 cycle of IC induction (45/52 [86.5%]). The induction regimen was 3 + 7 for 42/52 (80.8%) patients, among those, 3 (5.8%) received midostaurin along with the 3 + 7. Also 7/52 (13.5%) received CPX-351 as induction regimen. The median number of consolidation cycles was 2 [range: 0-6]; 8/52 (15.4%) patients did not receive any consolidation and 6/52 (11.5%) had >3 cycles of consolidation. The majority of patients (27/52 [61.4%]) received IDAC consolidation. The median time between AML diagnosis and Oral-AZA ATU request approval was 6.8 months [range: 1-98]. Because of the limited time frame of the ATU, follow-up is available for 14/52 patients, and the median follow-up is 21.8 days [range: 1-35]. During the follow-up period, one patient had a temporary interruption of Oral-AZA treatment due to grade 4 neutropenia. There was no reported permanent discontinuation of treatment related to an adverse event. Summary/Conclusion: The characteristics of the patients included in the Oral-AZA Early Access Program in France are in line with European label. These real-life results bring new insights in this population of patients who are not eligible to HSCT with high unmet need to prolong CR1. No unexpected safety signal was registered. Updated results will be presented at the meeting.

Asian Americans suffer within-community discrimination related to COVID-19

Asian Americans suffer within-community discrimination related to COVID-19

Trigger-based pathways to increase utilization of palliative care services for cancer patients: A multi-disciplinary approach.

e24007 Background: Palliative care involves services to improve the quality of life for chronically ill patients and their care teams. Use of palliative care has shown to decrease the utilization of resources and increase clarity of goals of care. Although acceptance of palliative care principles has been improving, we conducted a multidisciplinary project to increase the utilization of palliative care consult (PCC) and follow its effect of hospital-based outcome. Methods: IRB approved study involving patients on medical floors and in the ICU were conducted over 3 months with 1-month pre-intervention phase (PIP). We developed PCC triggers based on medical literature for the ICU and Medical floors to identify at risk patients likely to benefit from PCC on admission. Trigger questionnaire included but was not limited to the problem list at admission, comorbidities, requirements and availability of social support, and age > 80 years which were reviewed by the primary Nursing staff at admission assessment. Patients meeting any one of the triggers were eligible for PCC. The RNs would reach out to the primary team to notify them of patient’s eligibility for PCC. We adopted “opt in” model to request approval of the PCC. Outcomes measures included rate of PCC among triggered, code status change, and discharge planning. Triggers for pre-intervention were filled by EHR review. All the categorical variables were compared by chi-square test. Results: 344 (Median age - 69, 50.58% Female) patients were enrolled during the study with 93 (27.03%) cancer patients. 93/121 (76.86%) of PIP patients and 160/223 (71.74%) of intervention phase (IP) patients triggered the PCC. During PIP, proportion of triggered non-cancer and cancer patients referred for PCC were 9/73 (12.33%) and 6/20 (30.00%) respectively. During IP, proportion of triggered patients referred for PCC significantly increased compared to PIP to 28/99 (28.28%, p-value – 0.01) and 38/61 (62.30%, p-value – 0.01) for both non-cancer and cancer patients, respectively. During the IP, PCC was recommended significantly more times (p-value – 0.00) in cancer patients than non-cancer patients. Among all with PCC involved, 4/17 (23.59%) PIP and 8/59 (13.56%, p-value – 0.56) IP full-code cancer patients changed code status to DNR. Among the cancer patients, 10 (6 from ICU and 4 from medical floor) patients were discharged to home hospice compared to none in pre-intervention phase. Conclusions: Application of trigger-based pathways leads to early and increase utilization of palliative care services for all patients by identifying patients to benefit from early PCC. Among cancer patients, we found improvement in utilization of hospice services and clarification of their code status at discharge. Further studies are needed to standardize the procedure for increased integration of PCC into our hospital’s clinical models of care.

Crowdfunding using Ethereum Blockchain

Abstract: The rise of Blockchain technology enables us to create secure, trusted and decentralized apps. Crowdfunding is an online money raising strategy that uses small amounts of capital from a large number of individuals which finance a new business project. Crowdfunding makes use of the easy accessibility of vast networks of people through social media and crowdfunding websites to bring investors and entrepreneurs together. The main problem with the current websites is that they don’t provide the Contributor Assured Policy and they don’t have control over the money they donated. So, by using blockchain we can provide a safe, secure and transparent way for crowdfunding. In this work, we have provided interactive forms for campaign creation, contribution and request approval through which both campaign creators and contributors can easily create and pool the campaigns. Keywords: Blockchain, Ethereum, Smart Contracts, Crowdfunding.

STRATEGI KESANTUNAN BERBAHASA DALAM TALK SHOW Q&A DAN RELEVANSINYA TERHADAP PEMBELAJARAN BAHASA INDONESIA TINGKAT SMP

Abstract
 The purpose of this study to describe the politeness strategies of Brown and Levinson in the Q&A talk show and describe the relevance of politeness-language strategies towards learning Indonesian at the Middle School level. The theory used to solve the problem in this study is the theory of Brown and Levinson. While the approach used is descriptive qualitative approach with data collection techniques namely documentation techniques. The results of this study indicate that the forms of Brown and Levinson's politeness strategy that occurred in the Q & A talk show in August 2018 consisted of Brown and Levinson's first politeness strategy, namely without strategies found that included speech without strategy. The second strategy of brown politeness and Levinson's positive politeness strategy is found to pay attention to the opponent's speech, exaggerate attention, agreement, and sympathy, intensify the opponent's attention by dramatizing facts, intensify using group identity markers, request approval with general topics or repeat part or all, avoiding disagreement by pretending to agree, using jokes, expressing understanding of the wishes of speakers, giving offers or promises, showing optimism, involving speakers in activities, giving questions asking for approval, giving gifts. Where negative politeness strategies are found to be pessimistic, minimize coercion, and apologize. Finally, the Off Record strategy was found which was included in the strategy. The relevance of the results of the study can be applied in learning Indonesian in junior high school class IX 3.9-4.10.

Applications of a geographic information system–based business intelligence system for decision making at Coffee Refresh

This case is designed to illustrate how to utilize a business intelligence framework and a geographic information system to make better decisions on franchise opening requests. The case started when Jong, the senior certified analytics professional, and his team were drafting a proposal presentation on a new franchise approval process to present to Tony, the director of Coffee Refresh. Currently, Coffee Refresh was experiencing a significant delay in approving franchise opening requests. In addition, the current approval process was relied on the appraisal teams’ evaluations, which involved self-judgment as to the accessibility and visibility of the store location in each franchise opening request and a manual count of the potential targeted customers at each location, which impacted how the appraisal teams estimated the expected revenue for each location. During the first meeting with Jong and his team, Tony was frustrated by the current evaluation process, resulting in a significant backlog of requests pending approval, which was far behind the target for its franchise branch expansion strategy. It had also been reported that the branches that opened during the past few years had a relatively low success ratio (losses between 4.8% and 16.5%) and that the rate of branch closures had increased from 2% to 7.5%. Currently, eight franchise opening requests were pending, and Jong had to provide a recommendation for which requests should be approved. Coffee Refresh could approve all of them instantly, approve some of them, or even decline all of them. This was a great opportunity for Jong and his team to revisit the current franchise approval process and to demonstrate how business intelligence systems could improve the request approval process as well as address the issues of the current franchises’ underperformance and the closure rates.

517Challenges in data linkage – experiences from an upper gastrointestinal cancer data linkage study

Abstract Background Linked, population-level data is valuable for mapping patterns of care and evaluating health service utilisation, particularly in difficult-to-reach populations. Upper gastrointestinal (UGI) cancers have a dismal prognosis, creating difficulties engaging patients in research. The utility of a linked dataset in this population is of high value. Methods Key objectives included identifying the operational and feasibility issues associated with linking Australian state-based administrative and registry data for understanding health service utilisation in UGI cancers. Datasets pertained to hospital admissions, radiotherapy, community health, primary care, palliative care, Medicare and Pharmaceutical Benefits Schedule’s and UGI cancers. Results From a logistical perspective, data access request approval processes varied, with some requiring consent to be sought from individual services contributing data. The availability of unique person-level identifying information varied widely. Additionally, the time period of data capture differed between and within datasets, limiting the quality of the linked data. Significant costs were associated with linking with primary care and Medicare and Pharmaceutical Benefits Schedule’s. Federal dataset linkage required at least a one-year waiting period. Conclusions Whilst in theory data linkage is a powerful mechanism for obtaining population-level data, in reality, there are many logistical and financial barriers to linking multiple datasets. Consequently, critical data, which has the potential to inform policy and improve patient outcomes, cannot be procured. Key messages Logistical and financial challenges are associated with linking administrative and registry datasets for research, limiting the potential of data linkage.

Implementation and Impact of a Multidisciplinary Coagulation Factor Stewardship Program

Introduction: Coagulation factor products are costly and can cause adverse outcomes when used inappropriately. Active stewardship may reduce the risk of inappropriate use, increase the likelihood of safe and effective use, and help control costs. Such goals may be met when these products are dispensed from an inpatient pharmacy. After multidisciplinary discussions of unmet clinical needs and pharmacoeconomic concerns, coagulation factor product guidelines for use were established at our institution and a multidisciplinary stewardship program was implemented.Objective: The purpose of this quality improvement initiative was to implement a multidisciplinary coagulation factor stewardship program and ascertain its impact on the use of coagulation factor products after dispensing them from inpatient pharmacy instead of the blood bank.Methods: We compared the utilization of 4-Factor prothrombin complex concentrate (4F-PCC) and recombinant factor VIIa (rVIIa) from the period of 7/1/16 to 5/31/17, 6 months prior to and 6 months after implementation of the stewardship program. Prior to implementation, pharmacists, hematologists, surgeons, anesthesiologists, and intensivists met to develop hospital-wide guidelines and order sets for 4F-PCC and rVIIa. The guidelines include indications for which 4F-PCC can be dispensed without hematology consultation and the requirement for hematology consultation for approval of requests outside of these guidelines. The Pharmacy & Therapeutics Committee approved all guidelines, order sets and the hematology service stewardship. Data about approval, administration, cost, and outcomes were obtained retrospectively for the 6 months prior and prospectively for the 6 months after implementation of the stewardship program.Results: Pre-implementation, 30 patients received 4F-PCC and 7 received rFVIIa. Warfarin reversal prior to emergent surgery (n=18, 60%) was the most common indication for 4F-PCC, followed by warfarin reversal for major bleeding (n=9, 30%) and direct oral anticoagulant (DOAC) reversal (n=3, 10%). Vitamin K was administered to 78% of the patients requiring warfarin reversal. The indications for rFVIIa included FVII deficiency (n=3, 42%), hemophilia with inhibitors (n=2, 29%), and refractory major bleeding (n=2, 29%). Of all patients, 7 (19%) died before discharge, but not within 72 hours and 1 (3%) had a thrombotic event within 72 hours. The cost of 4F-PCC and rFVIIa during the 6 months preceding the stewardship program was $261,880.After stewardship was implemented, 34 patients received 4F-PCC and 3 received rFVIIa. Indications for 4F-PCC included warfarin reversal prior to emergent surgery (n=21, 62%), warfarin reversal for major bleeding (n=5, 15%), DOAC reversal (n=4, 12%), and peri-operative management of other coagulopathies (n=4, 12%). Vitamin K was administered to 88% of patients requiring warfarin reversal. The pharmacy dispensed the products according to institutional guidelines in 88% of cases, and without hematology consultation when it should have been obtained in 12% of cases. Hematology was consulted for stewardship in 6 cases; 2 were approved and 4 were denied for disseminated intravascular coagulation (DIC) (n=2), factor V deficiency without active bleeding (n=1), and surgical bleeding (n=1). Of all patients, 10 (24%) died before discharge, including the 2 with DIC who were denied product. Three (7%) died within 72 hours and 2 (5%) had thrombotic events within 72 hours. The cost for 4F-PCC and rFVIIa was $160,144 after stewardship was implemented.Conclusions: Dispensing 4F-PCC and rFVIIa from the inpatient pharmacy with stewardship has resulted in similar utilization and efficacy as existed in the pre-implementation period but with cost savings of $101,000 during the first 6 months of stewardship. Furthermore, implementation of a multidisciplinary coagulation factor stewardship program with standardized institutional guidelines, streamlined dispensing from the inpatient pharmacy, as well as use of expert hematologic consultation when indicated, has enhanced the culture of safety in our institution. The experience has also enriched the training of hematology fellows, residents and pharmacists. DisclosuresFongemie:Bristol Myers Squibb: Speakers Bureau. Comenzo:Janssen: Consultancy, Research Funding; Prothena: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; Karyopharm: Research Funding.

Factors associated with off-label (OL) drug use in oncology: The role of cost and financing in a universal healthcare system.

e18825 Background: In recent years, OL use in oncology has become widespread, with estimates ranging up to 50-75% of all prescriptions. Most OL use is not publicly reimbursed within universal healthcare systems. We aimed to characterize the financing sources of OL use and to identify predictors for forgoing such treatment. Methods: We studied 708 oncology OL prescription requests submitted for approval to the Institutional Drug Committee in Rabin Medical Center, a large tertiary center in Israel, between January 2016 and December 2018. We included only requests for patients that were alive for more than 60 days following prescription approval. For each indication we extracted the level of supporting evidence at the time of prescription (sufficient, limited, inadequate). We also examined patients’ disease and sociodemographic properties, treatment costs, and financing sources. We used univariable logistic regression to ascertain these variables’ effects on actual OL drug initiation. We then used multivariable logistic regression to explore predicting factors for drug initiation. Results: The median monthly cost of a planned OL treatment was ILS39,928 (approximately US$ 11,500). Approximately one third (31%) of the treatments did not have a financing source at the time of request approval. The primary financing sources were patient access plans (30%) and private health insurance (25%). Of 708 approved OL requests, only 583 (82.3%) treatments were initiated. The proportion of requests that were eventually initiated was higher in the metastatic versus adjuvant setting (84.9% vs. 76.5%; p= .008). The estimated median OS for metastatic patients was 9.9 months, significantly higher in patients that did initiate treatment versus patients that did not (10.4 vs. 7.2 months; p= .048). Although not significant, median costs of initiated treatments were higher compared to treatments that were not (ILS41,686 vs. ILS24,670). Prescriptions for the metastatic setting and immunotherapy as well as ones with sufficient evidence had higher odds for treatment initiation (OR = 1.73; p= .007, OR = 1.69; p= .013 and OR = 1.62; p= .016). Prescriptions with limited supporting evidence and with no planned financing source had lower odds for treatment initiation (OR = 0.59; p= .012, OR = 0.37; p< .0005). A multivariable logistic regression showed that if no financing plan was in place at the time of request, there was a 2.5 times higher likelihood of not initiating the treatment (OR = 2.5; p< .0005). Conclusions: While OL recommendation is widespread and institutional approval is granted, a substantial proportion of treatments are not initiated. Although cost was not associated with treatment initiation, having a planned financing source was a strong predictor for OL treatment initiation. This study elucidates the financing sources of OL treatments in a universal healthcare system and identifies access barriers.

Forms of Participation of the Investigator and Interrogator in the Process of Proving during the Application of Preventive Measures at the Stage of Pre-Trial Investigation

The article states that a systematic interpretation of the current CPC of Ukraine allows us to conclude that the subjects authorized to initiate the application of preventive measures at the stage of pre-trial investigation in criminal proceedings are the investigator, interrogator and prosecutor. Accordingly, a proposal was made that, in order to ensure a correct understanding and interpretation of the rules of criminal procedure legislation, it is necessary to make appropriate changes in Part 4 of Art. 176 of the CPC of Ukraine, providing for the coroner as a subject authorized to submit in agreement with the prosecutor a request for the application of a precautionary measure at the stage of pre-trial investigation. The article, based on a systematic analysis of the current criminal procedure legislation of Ukraine, identifies forms of participation of the investigator and interrogator in the process of proving during the application of preventive measures at the stage of pre-trial investigation in criminal proceedings, in particular: 1) drawing up petitions for the application of preventive measures and appealing to the prosecutor for their approval; 2) an appeal against the prosecutor's refusal to approve motions for the application of preventive measures. The analysis of the relevant forms of participation of the investigator and interrogator in the process of criminal procedural proving during the application of preventive measures has been made. It is established that the forms of participation of the investigator and the interrogator in the proving during the application of preventive measures at the stage of pre-trial investigation are the same, but the scope of powers within these forms is still different, in particular, the impossibility of the interrogator to initiate the application of certain preventive measures at the pre-trial stage. It is concluded that applying to the prosecutor for approval of requests for the application of preventive measures is an integral element and logical conclusion of the investigator and interrogator of such motions and a prerequisite for launching a mechanism for the application of preventive measures in criminal proceedings, because without the prosecutor's approval no important decision the investigator and interrogator at the stage of pre-trial investigation does not acquire legal force.

STRATEGI KESANTUNAN BERBAHASA DALAM TALK SHOW Q&A DAN RELEVANSINYA TERHADAP PEMBELAJARAN BAHASA INDONESIA TINGKAT SMP

The purpose of this study to describe the politeness strategies of Brown and Levinson in the Q&A talk show and describe the relevance of politeness-language strategies towards learning Indonesian at the Middle School level. The theory used to solve the problem in this study is the theory of Brown and Levinson. While the approach used is descriptive qualitative approach with data collection techniques namely documentation techniques. The results of this study indicate that the forms of Brown and Levinson's politeness strategy that occurred in the Q & A talk show in August 2018 consisted of Brown and Levinson's first politeness strategy, namely without strategies found that included speech without strategy. The second strategy of brown politeness and Levinson's positive politeness strategy is found to pay attention to the opponent's speech, exaggerate attention, agreement, and sympathy, intensify the opponent's attention by dramatizing facts, intensify using group identity markers, request approval with general topics or repeat part or all, avoiding disagreement by pretending to agree, using jokes, expressing understanding of the wishes of speakers, giving offers or promises, showing optimism, involving speakers in activities, giving questions asking for approval, giving gifts. Where negative politeness strategies are found to be pessimistic, minimize coercion, and apologize. Finally, the Off Record strategy was found which was included in the strategy. The relevance of the results of the study can be applied in learning Indonesian in junior high school class IX 3.9-4.10.

Data-Driven Machine Learning Approach to Integrate Field Submittals in Project Scheduling

AbstractConstruction projects are data-rich environments. However, those data are usually captured for site-specific reasons, e.g., the filing and approval of inspection requests, with little regar...